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The Downstaging Concept in Treatment-Resistant Depression: Spotlight on Ketamine

Alina Wilkowska, Wiesław Jerzy Cubała

International Journal of Molecular Sciences November 23, 2022 DOI: 10.3390/ijms232314605 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Theoretical or philosophical paper Peer reviewed
Intervention Ketamine
Topics Depression Ketamine Esketamine
Keywords Antidepressant Depression economics Resistance ecology Intensive care medicine Disease Psychotherapist
Citations 17
Key points Argues that ketamine as an add-on treatment for resistant major depressive disorder can reverse the process of increasing treatment resistance and global worsening of functioning.

Abstract

Treatment-resistant depression is a pleomorphic phenomenon occurring in 30% of patients with depression. The chance to achieve remission decreases with every subsequent episode. It constitutes a significant part of the global disease burden, causes increased morbidity and mortality, and is associated with poor quality of life. It involves multiple difficult-to-treat episodes, with increasing resistance over time. The concept of staging captures the process of changes causing increasing treatment resistance and global worsening of functioning in all areas of life. Ketamine is a novel rapid-acting antidepressant with neuroplastic potential. Here, we argue that ketamine use as an add-on treatment of resistant major depressive disorder, based on its unique pharmacological properties, can reverse this process, give hope to patients, and prevent therapeutic nihilism.

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